What is Strep A? Symptoms and how contagious bacteria is explained as child dies in outbreak at Surrey school

Group A Streptococcus bacteria can cause a range of infections.

A six-year-old child has died after a Strep A bacteria outbreak at a primary school in Surrey.

The death was confirmed by the UK Health Security Agency (UKHSA) South East’s health protection consultant Dr Claire Winslade. Another child is also being treated in hospital but is reportedly showing positive signs of recovery.

In an email to parents at Ashford Church of England School, it was confirmed that both pupils, in year one and year two, had caught the invasive Group A streptococcal (iGAS) infection. Antibiotics have been recommended to students and staff in the same year groups as the individuals affected.

Dr Winslade said: “We are extremely saddened to hear about the death of a pupil at Ashford Church of England School, and our thoughts are with their family, friends and the school community.”

So what is Strep A, what are the symptoms, and how can you become infected? Here’s what you need to know.

Group A Streptococcus usually causes mild illnesses such as a sore throat but can cause more serious infections. Credit: Getty Images

What is Strep A?

Strep A, which refers to Group A Streptococcus (GAS), is the name given to a type of bacteria sometimes found in the throat or on the skin. It usually causes mild illnesses such as a sore throat, but can cause other infections such as pneumonia and scarlet fever.

Usually associated with the Victorian Era, scarlet fever used to be a very serious illness but in the modern era most cases are mild and can easily be treated with antibiotics. The disease has seen a resurgence in recent years, with the number of cases in England hitting a 50-year high in 2016 – when some 17,000 infections were reported – and continuing to rise in each of the following years, government figures showed in 2020.

However, one of the most severe, albeit rare, illnesses caused by GAS is one called invasive Group A Streptococcal disease, which is life-threatening. This is an infection where bacteria gets into parts of the body where bacteria are not usually found, such as the blood, muscle or the lungs. It can lead to necrotizing fasciitis (infection of muscle and fat tissue) and streptococcal toxic shock syndrome (a rapidly progressing infection causing low blood pressure/shock and injury to organs such as the kidneys, liver and lungs).

Invasive GAS infection and scarlet fever are both notifiable diseases, which means health professionals must inform local health protection teams of suspected cases.

Scarlet fever is very infectious and can easily spread to other people

Is Strep A contagious and how does it spread?

GAS is spread by close contact between individuals, through respiratory droplets or direct skin contact. It can also be transmitted environmentally, though, such as via contact with contaminated objects.

The bacteria itself is considered contagious. This can then cause different diseases in different people.

What are the symptoms?

  • a high temperature
  • headache
  • sore throat
  • flushed cheeks
  • swollen neck glands

The bacteria can also cause a whitish coating to appear on the tongue, which eventually peels, leaving the tongue red, swollen and covered in bumps. This is often known as “strawberry tongue”.

When an individual contracts scarlet fever, a characteristic pinkish rash will usually appear on the body. According to the NHS, the rash looks like small, raised bumps and makes the patient’s skin feel rough like sandpaper. The rash starts on the chest and stomach before spreading.

Symptoms of invasive Group A Streptococcal disease include:

  • fever (a high temperature above 38°C)
  • severe muscle aches 
  • localised muscle tenderness
  • redness at the site of a wound
  • dizziness
  • confusion

How are Strep A infections treated?

Mild infections caused by Strep A, such as a sore throat, can be treated at home. Those with scarlet fever are usually given a course of antibiotics, which lowers the risk of complications and speeds up recovery time.

Those who think they have an invasive disease should get medical advice straight away. Some people can still receive antibiotics and be treated at home, but more at-risk individuals, such as those over the age of 65 or those with cancer, heart disease or diabetes, will be treated in hospital. In severe cases, an operation is needed but this is rare.